Clinical Scorecard: Scleral Trends: Mini-Scleral Designs and Toric Landing Zones

At a Glance

Key Highlights

• 60.8% of scleral lenses prescribed were mini-scleral designs.
• Use of mini-scleral lenses increased from 44% in 2016 to 74% in 2022.
• 99.8% of scleral lens fittings utilized toric landing zones.
• Mean number of lenses required for successful fitting was 1.4 ± 0.7.
• The introduction of bi-tangential mini-scleral lenses in 2018 improved fitting outcomes.

Guideline-Based Recommendations

Diagnosis

• Utilize diagnostic fitting sets for accurate scleral lens fitting.

Management

• Consider mini-scleral designs for most patients, except those who have undergone keratoplasty.

Monitoring & Follow-up

• Track fitting success rates and lens re-orders to optimize patient outcomes.

Risks

• Inadequate fitting may lead to discomfort or complications; ensure toric landing zones are used.

Patient & Prescribing Data

6,635 unique patients, median age 43 years.

Younger patients with keratoconus had a median age of 35 years; mini-scleral lenses are preferred for most indications.

Clinical Best Practices

• Employ the Visser fitting philosophy for scleral lens fittings.
• Monitor the anatomical scleral shape to determine the need for toric landing zones.
• Leverage practitioner experience to reduce the number of lenses needed for successful fittings.

References

• Scleral lens prescribing trends study
• Qualitative assessment of scleral shape patterns
• Clinical performance of a new bitangential mini-scleral lens
• Practitioner learning curve in fitting scleral lenses